Dear Dr. Garner,
I just got my mammogram report and am very upset to read that I have dense breasts. I never had a problem before and now have received this letter. I have scheduled an appointment to meet with my family doctor.
What does this really mean to me? How come I didn’t hear about it before if it is so important?
What should I do?
Dense Breast in
Ditmas Park
Dear Dense,
Your anxiety and confusion mirrors that of many women who have received notice that they have dense breasts. On Jan. 19, 2013, the “dense breast law” went into effect. It requires notification to women after their mammogram if they have dense breasts.
Why is this important information? Breasts are composed of different types of tissues, such as glandular tissue that makes milk and fatty tissue. Dense breast appears white on mammograms, and fatty tissue appears black. Tumors also appear white on mammograms. Therefore, a tumor might be hidden in a woman with dense breasts due to the fact that it is camouflaged by the same color background.
Determined by Mammogram
At least 40 percent of women have dense breasts. It represents a variation in the appearance of the breasts on mammograms. Defining of dense breast can only be determined by the image on the mammogram. It cannot be determined by size, or shape or physical exam.
The state felt it was important for women to know if they have dense breasts for two reasons.
The mammogram in a woman with dense breasts is difficult to interpret, and a tumor might not be recognized by the radiologist due to the fact that it has the same appearance as dense breast tissue (white in color).
There is an increased risk of cancer – about six times the average – in women with dense breasts.
In the past, women were never notified of the density of their breasts. In some instances the mammogram was read as negative, yet there was a tumor hidden and growing.
If a woman has dense breasts, what should she do? Women with dense breasts should meet with their doctor to determine whether additional screening tests should be performed. This could include sonograms and MRIs of the breast.
These tests can often identify a tumor that the mammogram might have missed in dense breasts. A problem with these tests is that there are many false positives and women may undergo many unnecessary biopsies.
A woman with dense breasts should schedule an appointment with her physician to determine her overall risk for breast cancer.
Additional Screening Measures
If there is a moderate to high risk, then I suggest a woman with dense breasts have additional screening (sonogram or MRI). If there is low risk for breast cancer, the patient and her doctor can decide together if yearly mammogram follow-up is appropriate.
For women who do not have dense breasts, they should continue with their yearly mammogram after age 40.
In summary, as a result of the dense breast law, all women undergoing mammograms are to be notified if they have dense breasts. This determination cannot be made by physical exam, only by the image on the mammogram. There is no need to panic. While there is increased risk of cancer in women with dense breasts, it is similar to other risk factors such as smoking, drinking, having a mother or sister with breast cancer or having abnormal genes that predispose to breast cancer.
Meeting with your doctor allows you to become more proactive in your health care. You and your physician can determine what is right for you. At the current time, we are awaiting more research on this topic to help determine if additional tests should be performed.
Thank you for your timely question. I hope this helps others as well.[hr] Dr. Steven Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on The NET, Tuesdays at 8 p.m. on Channel 97 Time Warner and Channel 30 Cablevision.
